Carotid Angioplasty with Stenting

Carotid artery angioplasty with stenting (CAS) is a minimally invasive procedure that reduces the risk of stroke by eliminating or reducing an obstruction in the carotid artery. It is often performed in patients for whom open surgery is risky.

What to Expect:

Preparing for CAS

A few days before your procedure is scheduled to be performed, you’ll visit the hospital for blood tests, a chest x-ray and an electrocardiogram, all of which will give your medical team information to help them plan your procedure. You’ll be asked not to eat or drink for eight hours before the procedure.

Undergoing the Procedure

When you arrive at the hospital, you’ll be given an identification bracelet and a hospital gown to wear during the procedure. A nurse will meet you in the recovery room. He or she will review your medications, take your blood pressure and insert a needle connected to a flexible tube, or IV line, into your arm. You’ll also be greeted by the doctor who will perform your test. He or she will review your procedure with you and get your informed consent. If your groin is to be the insertion site it will be shaved in preparation.

You will then be brought into the catheterization laboratory or “cath lab” and helped onto the examination table. The area of your groin or arm where the catheter will be inserted will be cleansed with antiseptic soap. If your groin is used, it will be covered with a sterile drape so that only a 2-inch area will be exposed. If your arm is used, the incision will be made on the inner arm at elbow level.

A member of the medical team will place electrodes on your chest, which will be connected to the machine that will monitor your heart function. You’ll be given a mild sedative through the IV line. You may feel a little drowsy and may even drift in and out of sleep. A local anesthetic will be injected into the skin where the incision will be made. It may sting.

Once the area is numb, the doctor will make a small incision to locate the blood vessel by inserting a sheath into the artery and guiding a catheter through it into your carotid artery.

A dye, or contrast agent, will be infused into the catheter. You may feel a brief sensation of warmth just after the dye is injected. The dye will highlight your carotid artery on a monitor. X-ray pictures will be taken.

An emboli prevention device (EPD), or cerebral protection device, will be positioned in the artery so as to “catch” any clots or small debris that should break loose from the plaque (the material that forms the obstruction).

After the narrowed portion of the artery is located, the angioplasty catheter will be advanced to that location and the balloon will be inflated to open the artery.

After the plaque has been flattened against the artery wall, a stent—a tiny, cylinder-like tube made of thin metal mesh framework—may be placed to keep the artery open. The stent will be advanced up into the aorta, placed in the carotid artery and expanded in a spring-like fashion to attach to the wall of the carotid artery. Another x-ray picture will be taken to verify the position of the stent.

At the end of the procedure, the angioplasty catheter will be removed. The sheath may be left in place or removed at the same time, and the incision closed with a vascular closure device.

You will be assisted onto a bed-like gurney and taken to the recovery area.

After CAS

After the procedure you will be taken to the recovery room for observation. Once your blood pressure, pulse and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room. If the catheter was inserted in the groin, the knee of the affected leg may be loosely restrained to keep you from bending your leg for several hours. A nurse will monitor your vital signs, your neurological signs and the injection site. You may be given medication for pain at the insertion site or for the after-effects of lying still for a prolonged period.

If the sheath was left in the insertion site, it will be removed and the incision closed. You will rest in bed for a few hours.

After the specified period of bed rest has been completed, the nurse will assist you up and will check your blood pressure while you are lying, sitting and standing.

You may be discharged from the hospital as soon as the next day, depending on your progress. You may be advised not to do any strenuous activities or take a hot bath or shower for a period of time after the procedure.

Once at home, you should monitor the insertion site for bleeding and for changes in temperature or color, pain, numbness, tingling or loss of function of the limb. Your physician may want to schedule you for follow-up duplex ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans to monitor the carotid arteries in your neck for a prescribed period of time. If you have a stent, your doctor will likely prescribe aspirin and clopidogrel to prevent blood clots from forming at the site where the stent is placed.